Ending AIDS as a public health threat by 2030: Time to reset targets for 2025

Lay, Paul R. De; Benzaken, Adèle Schwartz; Karim, Quarraisha Abdool; Aliyu, Sani H; Amole, Carolyn; Ayala, George; Chalkidou, Kalipso; Chang, Judy; Clayton, Michael; Couto, Aleny; Dieffenbach, Carl W.; Dybul, Mark; Sadr, Wafaa El; Görgens, Marelize; Low‐Beer, Daniel; Mesbah, Smail; Saveedra, Jorge; Sirinirund, Petchsri; Stover, John; Syarif, Omar; Taslim, Aditia; Thiam, Sylla; Njenga, Lucy Wanjiku; Ghys, Peter D.; Izazola-Licea, José Antonio; Frescura, Luisa; Lamontagne, Erik; Godfrey‐Faussett, Peter; Fontaine, Christopher; Semini, Iris; Hader, Shannon

doi:10.1371/journal.pmed.1003649

Cited by 34 publications

(32 citation statements)

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“…Disruptions in health services have the potential to lead to excess numbers of new HIV infections and AIDS-related deaths [ 34 ]. Based on data collected by UNAIDS on monthly services disruptions during 2020 [ 5 ], we examined the potential effects of disruptions on the impact of these targets by modeling 3 Coronavirus Disease 2019 (COVID-19) scenarios with disruptions starting in April 2020 and lasting 3 months, 6 months, or 2 years. During the disruption we, assumed that the rate of increase in ART coverage would be half of the pre-COVID-19 rate, no new VMMC during this time, 20% reduction in PMTCT services, and no PrEP scale-up.…”

Section: Methodsmentioning

confidence: 99%

Section: Covid-19 Disruptionsmentioning

confidence: 99%

“…By 2020, the annual global number of new infections had fallen by only 31% from 2010 and AIDS deaths by only 47% [4]. UNAIDS worked with a wide range of stakeholders to review past efforts [5] and propose a new set of programmatic targets for 2025 to speed progress toward achieving the 2030 goals [6]. Papers describing the process and background research that contributed to the strategy development are available in the PLOS Medicine Special Collection "UNAIDS HIV Targets" (https://collections.plos.org/collection/unaids-hiv).…”

Section: Introductionmentioning

confidence: 99%

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Modeling the epidemiological impact of the UNAIDS 2025 targets to end AIDS as a public health threat by 2030

et al. 2021

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Background UNAIDS has established new program targets for 2025 to achieve the goal of eliminating AIDS as a public health threat by 2030. This study reports on efforts to use mathematical models to estimate the impact of achieving those targets. Methods and findings We simulated the impact of achieving the targets at country level using the Goals model, a mathematical simulation model of HIV epidemic dynamics that includes the impact of prevention and treatment interventions. For 77 high-burden countries, we fit the model to surveillance and survey data for 1970 to 2020 and then projected the impact of achieving the targets for the period 2019 to 2030. Results from these 77 countries were extrapolated to produce estimates for 96 others. Goals model results were checked by comparing against projections done with the Optima HIV model and the AIDS Epidemic Model (AEM) for selected countries. We included estimates of the impact of societal enablers (access to justice and law reform, stigma and discrimination elimination, and gender equality) and the impact of Coronavirus Disease 2019 (COVID-19). Results show that achieving the 2025 targets would reduce new annual infections by 83% (71% to 86% across regions) and AIDS-related deaths by 78% (67% to 81% across regions) by 2025 compared to 2010. Lack of progress on societal enablers could endanger these achievements and result in as many as 2.6 million (44%) cumulative additional new HIV infections and 440,000 (54%) more AIDS-related deaths between 2020 and 2030 compared to full achievement of all targets. COVID-19–related disruptions could increase new HIV infections and AIDS-related deaths by 10% in the next 2 years, but targets could still be achieved by 2025. Study limitations include the reliance on self-reports for most data on behaviors, the use of intervention effect sizes from published studies that may overstate intervention impacts outside of controlled study settings, and the use of proxy countries to estimate the impact in countries with fewer than 4,000 annual HIV infections. Conclusions The new targets for 2025 build on the progress made since 2010 and represent ambitious short-term goals. Achieving these targets would bring us close to the goals of reducing new HIV infections and AIDS-related deaths by 90% between 2010 and 2030. By 2025, global new infections and AIDS deaths would drop to 4.4 and 3.9 per 100,000 population, and the number of people living with HIV (PLHIV) would be declining. There would be 32 million people on treatment, and they would need continuing support for their lifetime. Incidence for the total global population would be below 0.15% everywhere. The number of PLHIV would start declining by 2023.

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Section: Methodsmentioning

confidence: 99%

Section: Covid-19 Disruptionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Modeling the epidemiological impact of the UNAIDS 2025 targets to end AIDS as a public health threat by 2030

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“…Evaluation of the universal “test and treat” interventions could include assessment of the intervention’s impact on the health outcomes among those in the communities assigned to immediate ART scale-up, but who did not receive immediate ART themselves. As in vaccine campaign design, this could inform the level of ART coverage needed to benefit the community and consistently achieve such targets as the UNAIDS 2025 [43].…”

Section: Discussionmentioning

confidence: 99%

Assessing Direct and Spillover Effects of Intervention Packages in Network-Randomized Studies

Buchanan

Hernández-Ramírez

Lok

et al. 2022

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Intervention packages may result in a greater public health impact than single interventions. Understanding the separate impact of each component in the overall package effectiveness can improve intervention delivery. We propose an approach to evaluate the effects of a time-varying intervention package in a single study. In some network-randomized studies, only a subset of participants in exposed networks receive the intervention themselves. The spillover effect contrasts potential outcomes among persons not exposed themselves but in an intervention network to those in a control network. We estimated effects of components of the intervention package in HIV Prevention Trials Network 037, a Phase III network-randomized HIV prevention trial among people who inject drugs and their risk networks using Marginal Structural Models to adjust for time-varying confounding. The index participant in an intervention network received a peer education intervention initially at baseline, then boosters at 6 and 12 months. All participants were followed to ascertain HIV risk behaviors. There were 560 participants with at least one follow-up visit, 48% of whom randomized to the intervention, and 1,598 participant-visits were observed. The spillover effect of the boosters in the presence of initial peer education training was a 39% rate reduction (95% confidence interval (CI) = -57%, -13%). These methods will be useful for evaluation of intervention packages in studies with network features.

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“…Although evidence-based medicine remains the gold standard for decision-making in healthcare [ 6 ], randomised controlled trials of health system interventions are extremely time-consuming and often have low external validity because their results are context-specific [ 7 ]. As part of the PLOS collection on Joint United Nations Programme on HIV/AIDS (UNAIDS) HIV targets [ 8 ], we use the case of health service integration for HIV in low- and middle-income countries (LMICs) to outline existing frameworks and provide guidance on how to best utilise the existing evidence in policymaking and, in particular, how to design implementation strategies for integration opportunities where high-level causal evidence is scarce or lacking.…”

Section: Introductionmentioning

confidence: 99%

Evidence-based policymaking when evidence is incomplete: The case of HIV programme integration

et al. 2021

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Ending AIDS as a public health threat by 2030: Time to reset targets for 2025

Abstract: Paul De Lay and co-authors introduce a Collection on the design of targets for ending the AIDS epidemic.

Cited by 34 publications

References 7 publications

Modeling the epidemiological impact of the UNAIDS 2025 targets to end AIDS as a public health threat by 2030

Modeling the epidemiological impact of the UNAIDS 2025 targets to end AIDS as a public health threat by 2030

Assessing Direct and Spillover Effects of Intervention Packages in Network-Randomized Studies

Evidence-based policymaking when evidence is incomplete: The case of HIV programme integration

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